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General NPI Number Information
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NPI Number | 1396816930
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Entity Type | Individual
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Provider Name | TY A WHITE MD
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 1100 E 26TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57105-4023
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Country | US
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Telephone | 605-338-7098
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Fax | 605-335-3505
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Provider Business Mailing Address
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Address Line | 3908 S PILLSBERRY AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57103-7273
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Country | US
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Telephone | 605-331-0662
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Fax | 605-335-3505
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 5204
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License Number State | SD
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